Sounds like capitation to me. Blue Cross & Blue Shield of Massachusetts is proposing to overhaul the way it pays doctors and hospitals. The plan wants to stop paying doctors and hospitals for each patient visit or treatment, and instead wants to pay a flat sum per patient each year. The fee would be adjusted for age and sickness, and would include a bonus if the providers improve care. . . . Updated rates of uninsured women categorized by state have just been issued by the Kaiser Family Foundation. The rates range from a high of 28 percent of women 18–64 (Texas) to a low of 9 percent (Minnesota). Among low-income women, in the same age group, the uninsured rate ranges from 51 percent (Texas) to 20 percent (Maine and Vermont). . . . The slowdown in health spending growth is not likely to last, according to a report issued by the Center for Studying Health System Change. Government economists report that personal health care spending — the portion of national health care spending that accounts for health care goods and services, grew 6.6 percent in 2006, just a hair below 2005’s 6.8 percent growth.
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.